Progressive Politics in Minnesota, the Nation, and the World

MNSure Critic And Non-Supporter, Rep. Mack Says She Will Fix It?

Rep. Tara Mack voted against the creation of a health care exchange. She worked to delay its implementation. When the state hurried its way into making an exchange, she offered no suggestions or help. When MNSure had its rollout problems, she was quick to criticize but offered no solutions. When the exchange successfully enrolled 183,000 Minnesotans, she focused on the software issues and glitches. When studies showed that Minnesota's uninsured rate declined by 40%, she said nothing.

But now we are supposed to believe that Rep. Tary Mack is going to work on fixing the system and "make it better".

Rep. Tara Mack, R-Apple Valley....sponsors House File 5, which would direct the commerce commissioner to ask the federal government for a 1332 waiver under the Patient Protection and Affordable Care Act. The waiver would allow qualified health plans to be sold outside of MNsure -- but eligible consumers would still receive federal subsidies. We should expand choice without making insurance purchasing as "frustrating, awkward and inconvenient" as MNsure has made it, Mack said.

In other words, Mack is working to give the power back to the insurance companies.

If, as Mack suggests, we take enrollment outside of MNSure, then insurers would have to have access to eligibility data to allow for tax subsidies. That would require them to have IRS data. Some have suggested that MNSure could still determine eligibility, but that outside insurers could then offer the plans with the subsidies. If we just let insurers get access to our private financial data, how can our data be protected? And if we use MNSure to determine that eligibility, then why would we even need the fix? The determination of eligiblity has been the main problem for MNSure from the beginning. Once the eligibility has been verified, MNSure becomes a simple shopping exchange.

Frankly, we have already been working to fix the initial problems that plagued MNSure - an IT nightmare. During the second enrollment, many of those problems went away. We still have things to fix, but what Rep. Mack is proposing is to make another major change in how this system operates....and what guarantee do we have that more software and data privacy issues don't occur?

Having our own state exchange has increased importance as the Supreme Court makes its determination on the ACA language involving those exchanges. We need to protect the Minnesotans that now have health insurance that they couldn't get before the ACA.

Rep. Mack is not going to give that protection. And her past record on MNSure has never been involved with support for the exchange - it has always been an effort to destroy it.

How can we trust someone like that to offer new legislation on this issue?

Downey's "Fixes" for MNSure Are More Bunk

I need to respond to an OP-ED in the Star Tribune by Keith Downy, chair of the Minnesota Republican Party and obvious MNsure critic.

It is a bit surprising that Downey and the MN GOP suddenly think of themselves as some kind of "savior" for MNsure - especially when they actively blocked its beginning, did nothing to work on the bill that brought it into being, have not bothered with helping in its evolution, and are still actively seeking to kill it with every opportunity.

So the idea of having the "cure" has to be viewed somewhat skeptically.

But at least, for once, Downey puts forward some actual remedies. Let's take a look....

1. Only 9 percent of MNsure enrollees actually bought the private coverages, and these enrollees don't need MNsure's failed technology to find their insurance. H.F. 5, authored by Rep. Tara Mack, R-Apple Valley, proposes waivers allowing enrollees to take their government subsidy to private-sector insurance exchanges, which already offer Obamacare-compliant private coverages and work perfectly. We should free these MNsure-locked customers to shop wherever they want! Using the federal exchange could also be evaluated.

Private plans have been key to MNsure's viability. And the horrible website has chased away most of the people that wanted to buy a private plan. But there is a flaw in the Mack bill. If we allow the federal subsidies to be used by the private sector, we will have a gigantic privacy issue. The exchanges and Fed website were designed to use data gathered from the IRS to determine those subsidies. One of the problems in forming these exchanges is how to keep that data safe and private. What the Mack bill does is potentially open that income data to insurance carriers, which to me would be a bigger disaster than software problems.

2. The 91 percent enrolled in government's MinnesotaCare and Medicaid programs, which have been available for years, were enrolled through the regular process and systems at the Minnesota Department of Human Services (DHS). They can continue to be. These enrollees do not need MNsure to get their coverage either!

Yes, many of them were eligible before. And many more became eligible with the Medicaid expansion. Except why were they not getting that coverage before? One of the reasons is that they didn't know about the programs or know that they were eligible. The MNsure exchange has been a valuable tool for determining all of that. Granted, the software has still made part of that journey into coverage a little tedious, but the overwhelming numbers of new MNCare and Medicaid recipients means that our overall uninsured rate has dropped by 40%. Would that have happened without MNsure? Maybe some of it - but it is hard to imagine Republicans signing onto new outreach programs to find them.

I'm not sure how this is worded, but it is hard to imagine that we actually know what is unnecessary at this time. The MN Comprehensive Health Association is a favorite of Republicans because it only provided catastrophic coverage - few prescriptions or any preventive medicine. It was cheap insurance because it covered only the extreme health event. The MN GOP would love to bring that back.

4. Evaluate whether any components of MNsure's technology or operations could be salvaged by the DHS to improve the enrollment process for MinnesotaCare and Medicaid. If not, shut them down altogether.

We do have serious problems coordinating MNsure to our state health programs. Lots of improvement is needed here and they need to "talk" to each other much more efficiently. It might be better to have MNsure determine eligiblity for these plans and then turn over the files to MNCare or Medicaid from there. MNsure seems to have complicated matters with state recipients and that does need to be fixed.

Downey is good at listing complaints about MNsure - GOPers in general have made it a political sport. But his idea of "real" fixes is pretty shallow at best - and will make things more complicated at worst.

I am sure we would all like the MN GOP to be a partner in solving the MNsure problems, but Downey's words are no evidence of that.

GOP: It Is Just What They Do

GOP LEG: Wow, you guys must be in major damage control. Did you see that Auditor report on MNsure? Man, that was bad. Yowser...really bad. Told ya it would be. Told ya so. Hot damn.

DFL LEG: Yeah, It was a tough one. Of course, it was pretty much stuff we already knew. Bad website. Bad management. We covered this pretty thoroughly.

GOP LEG: Yeah, but don't you feel really, really bad? That report was just awful. You guys must be shakin' in your boots. Gotta love a good scathing report like that.

DFL LEG: Well, things are getting better. Wait times were under 3 minutes this time around. And despite the report, over 370,000 Minnesotans got health care and the uninsured rate dropped by 40%. Gotta be happy with that.

GOP LEG: Yadda. Yadda. Yadda. But the report was just sooooo bad. Nothing worked right and wasn't that April Todd-Malmlov a piece of work? Gosh, I'm gonna love the hearings on this. It is going to be great!

DFL LEG: More hearings? I thought the report pretty much said it all don't you? What exactly are hearings going to accomplish?

GOP LEG: Oh, man, really? Hearings are the big chance to go over it all over again. It'll be great! We can call up all the MNsure staff and rake them over the coals. Bring in some of those unhappy callers who had to wait for hours. We can call Todd-Malmlov to testify and she can do her refusal thing. Great stuff. It'll keep the papers busy for weeks.

DFL LEG: Seriously? MNsure is doing much better now. Why bring all that stuff up again? Besides, we've got to get going on transportation. Broadband for rural areas. Debate on Pre-K. College tuition freeze. Maybe even a bonding bill. We have stuff to do.

GOP LEG: Oh heck. We got time for all that. Can't pass up the optics of this really, really bad report. I mean we have to point out how bad it was pretty much every day until the end of session. It was just sooooo bad. I love it. We'll get to that other stuff later....people still want to hear about that really bad auditor report.

DFL LEG: Yeah, well, I guess you do what you gotta do.

GOP LEG: Oh, yeah. That is what we are the best at doing. By the way, how about those Commissioner pay raises? Wasn't that just outrageous? I love it!